Public Health Assessment and Wellness

This practice addresses food borne disease transmission prevention and intervention. The overarching goals were to 1) have a comprehensive integrated food safety program that successfully focuses on both prevention and intervention of food borne illness; 2) improve the infrastructure for foodborne illness surveillance in Multnomah County and 3) develop a food handler training program for persons who are functionally illiterate, including limited and non-English speakers. The key objectives were:

To educate and certify a diverse population of Food Handler Workers in Multnomah County.

To determine which FBI complaints should be investigated and responded to as FBI cases.

This practice addresses food borne disease transmission prevention and intervention. The overarching goals were to 1) have a comprehensive integrated food safety program that successfully focuses on both prevention and intervention of food borne illness; 2) improve the infrastructure for foodborne illness surveillance in Multnomah County and 3) develop a food handler training program for persons who are functionally illiterate, including limited and non-English speakers. The key objectives were:
To educate and certify a diverse population of Food Handler Workers in Multnomah County.
To determine which FBI complaints should be investigated and responded to as FBI cases.

This practice addresses food borne illness (FBI) transmission prevention and intervention. In 2003, MCED conducted an analysis of our FBI prevention and intervention practices to determine if we met FDA Food Program Standards, using CDC methods. The CDC estimates food eaten outside the home (e.g., at restaurants) accounts for more than 40% of food borne illness. Food borne illness cause lost productivity, medical expenses and premature death of around $5 million per year in Multnomah County.Food safety education is the first line of defense to prevent FBI disease transmission.
Food Handler testing failure rates and surveys indicated a need for a culturally/linguistically competent educational tool that could be easily accessed and understood. The new website meets the needs of our community’s increasingly diverse populations because the information is available in seven languages (English, Spanish, Russian, Vietnamese, Mandarin, Cantonese, and Korean). MCEH’ second line of defense is active FBI surveillance. The new database supports a timely/appropriate response, coordination of services, implementation of epidemiologic best-practices and trend analysis. FBI complaint data are entered directly into the database. The information is analyzed through queries and cross-referencing historical information stored in the database and secondary, linked inspection database for information correlating to a FBI outbreak.

Agency Community RolesMultnomah County Health Department Environmental Health was the sole developer of the online system. During the development phase, we collaborated with key stakeholders such as the Food Service Advisory Committee, Oregon Health Services, and food handlers to ensure the model reflected community needs and met legislative standards. MCEH is assisting Sherman, Wasco and Yamhill counties in Oregon as to implement the online system in their counties. Ohio, North Carolina and Oregon’s Curry County have contacted MCEH to acquire the oral educational and testing tools.
To accompany the database, MCEH developed a manual that details how the FBI database is used, and how Multnomah County Health Department will investigate and respond to foodborne illness complaints within its jurisdiction. These procedures were developed collaboratively across departments and across agencies with technical support from the FDA Regional Specialist in order to make FBI complaint follow-up more efficient and effective in preventing disease transmission. Implementation of the model was launched by conducting a FBI tabletop exercise that included MCEH, Multnomah County Communicable Disease, Oregon Health Services, and the Department of Agriculture. This was facilitated by the FDA Regional Specialist. The International Association for Food Protection is revising their FBI investigation manual to model the MCEH format.
Costs and ExpendituresGrant funds were secured from the following sources to support the development, implementation and evaluation of the practice model: Food and Drug Administration (FDA) Food Safety Education Program, NACCHO Food Safety Demonstration Program, FDA Regional Partnership Fund, and CDC Delivering Environmental Health Services Program. From July 2005 through January 2006, the website has generated $65,585 dollars in new revenue—the annual revenue projection is $122,500, which will not only cover all operating and maintenance expenses of the web site, but will provide funds to support other EH activities.
ImplementationThe steps to update the FBI database occur as quickly as possible after a FBI complaint is received. The steps include:
FBI characteristics and information is collected over the phone.
Information is simultaneously entered into the database while the Environmental Health Specialist (EHS) is collecting the information.
Within one minute of completed data entry the computer calculates the risk score; if the score is six or higher, the Health Department Communicable Disease Unit is notified and the investigation begins.
Within twenty-four hours of the computer calculating a score of six or higher, MCEH conducts a facility investigation to locate the source of FBI.
MCEH and Health Department have ongoing correspondence with necessary parties including hospitals, emergency personnel, health officer, food facility operator, laboratory, and epidemiologist during the investigation process.
Appropriate interventions are put into place to prevent disease transmission and minimize impact of the outbreak.
Ongoing education is provided to community members and food service workers regarding safe food handling practices.
Trend analysis is conducted to identify revisions to this model practice.

An evaluation of the online food handler website occurs regularly. To collect process evaluation data, random calls are made to 50 users which provide valuable feedback on survey design and functionality semi-annually. An outcome evaluation is also conducted semi-annually. Data indicates that the online tests are reaching different non-English speakers. Over 5% of those taking tests are foreign language speakers. Of those answering feedback questions, the online testing has a 99% satisfaction rate.
During development of the FBI database, it was tested and evaluated by the cross-department team for effectiveness of design and functionality, to ensure that the program was able to forecast likely FBI outbreaks. The FDA Food Program Standard audit determined that the database, manual and compliant/investigation system fully met FDA Voluntary Food Program Standard Number 5.

The online food handler education and testing website will be sustained by the revenues it generates. Every time a user takes the food handler certification test online, they are charged $10.00. If a user wants to print a duplicate copy of their card at a later date due to loss they are charged $5.00. From July 2005 through February 2006, the website has generated $65,585 dollars in new revenue that will cover all operating and maintenance expenses. MCEH is also collaborating with other county and state jurisdictions who would like to use the website. The revenue will be split between the two counties. Over the last six months the revenues generated from the website has continued to rise, which indicates that the community will continue to perpetuate the practice. Even if revenues level off, the website can be perpetuated by partnering with other county and state jurisdictions as detailed in the Collaboration/Agency roles section.
The ongoing operating costs for the FBI database are minimal so it will be sustained by the revenues generated from facility licensing fees. Key stakeholders such as the FDA, Oregon Restaurant Association, Oregon State Health and Department of Agriculture have expressed continual support of the model and encourage MCEH to present the model to other jurisdictions throughout the nation at conferences so that the practice can be perpetuated in a broader venue.